急性ST段抬高性心肌梗死不同手术时机的效果比较  

Comparative analysis of different surgical timing for coronary artery bypass grafting(CABG)in patients with acute ST segment elevation myocardial infarction

作　　者：刘敬巍 王媛姗 池一凡[2] 吴建涛[1] 林明山[1] 乔友进[1] 黄强[1] LIU Jingwei;WANG Yuanshan;CHI Yifan(Department of Cardiovascular Surgery,Qingdao Municipal Hospital,Medical College of Oingdao University,Shandong,Qingdao 266011,China;不详)

机构地区：[1]山东省青岛大学附属青岛市市立医院心外科,266011 [2]山东省青岛大学附属青岛市海慈医院心外科

出　　处：《临床外科杂志》2022年第11期1049-1052,共4页Journal of Clinical Surgery

摘　　要：目的比较急性ST段抬高性心肌梗死(STEMI)行冠状动脉旁路移植术(CABG)不同手术时机的效果。方法我院心脏外科2009年1月~2017年12月行CABG手术病人206例,根据治疗时间不同分为3组,A组30例,STEMI后急诊/紧迫性CABG;B组66例,稳定的STEMI病人急性心肌梗死1周后30天内行CABG;C组110例,同期需择期行CABG手术非心梗病人;比较3组病人的一般资料、手术方式、冠脉病变、移植材料、术后并发症、围手术期死亡率、ICU住院时间、主动脉内球囊反搏(intra-aortic balloon pump,IABP)应用;门诊或电话方式随访,记录出院至最后1次随访时间及一般资料。结果3组移植血管数目、移植材料比较,差异无统计学意义;A组分别与B组和C组间围手术期死亡率、术后并发症(低心排血量、多器官功能衰竭、心律失常)及IABP的应用比较,差异有统计学意义(P<0.05),B组和C组间比较差异无统计学意义(P>0.05)。3组ICU住院时间比较差异有统计学意义(P<0.05);随访183例,随访率88.8%,随访时间10~26个月[(20.7±3.12)个月],其中A组死于脑血管意外1例,C组死于交通事故1例,B组随访期间无死亡。结论对于稳定的STEMI病人心肌梗死发生1周后30天内行CABG安全,可改善病人的预后;对于心源性休克、持续性心肌缺血及合并机械并发症的病人应积极行急诊CABG治疗。Objective To compare analysis of different operation timing of coronary artery bypass grafting(CABG)for acute ST segment elevation myocardial infarction(STEMI).Method We retrospectively analyzed the clinical data and results of 206 patients who underwent CABG from January 2009 to December 2017 in Qingdao Municipal Hospital.There were 30 emergency/urgent surgeries(group A).Stable STEMI patients who underwent CABG after acute myocardial infarction 1 week within 30 days had 66 cases(group B).Randomly selected 110 patients with non-myocardial infarction undergoing elective CABG in the same period(group C).Comparing the general clinical data,surgical methods,coronary artery lesions,transplantation materials,postoperative complications,perioperative mortality,time of ICU stay,and IABP application of the three groups of patients.To follow these patients in cardiac surgery clinic or by telephone,and recording the time from discharge to the last follow-up and general clinical data.Result There was no statistically significant difference in the number of transplanted blood vessels and materials among the three groups.There was a statistically significant difference between group A and group B or between group A and group C in mortality,postoperative complications(low cardiac output,multiple organ failure,arrhythmia)and the use of IABP(P<0.05).The difference between group B and group C was no significant(P>0.05).Significant differences among three groups(A、B、C)at ICU time.A total of 183 patients were followed up by a follow-up rate of 88.8%with a period ranged from 10 to 26 months(20.7±3.12 months).One patient died of cerebrovascular accident in group A,one patient died of a traffic accident in Group C and there was no death in group B during follow-up.Conclusion CABG is safe for stable STEMI patients after 7 days of myocardial infarction within 30 days with full preoperative preparation and can improve the patients survival.The patients with cardiogenic shock,persistent myocardial ischemia and mechanical concurrency s

关 键 词：急性心肌梗死 冠状动脉旁路移植术 死亡率 

分 类 号：R654.2[医药卫生—外科学]